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Men, those with a comfortable social life and smokers trying to quit tobacco are among populations most likely to participate in lung cancer screening programs, according to a French report published in Clinical Lung Cancer this summer.

Since the U.S. Preventive Services Task Force released a statement recommending annual low-dose CT screenings over traditional chest x-rays for preventing and reducing lung cancer mortality, yearly CTs have been standard practice at many an organization, lead investigator Sébastien Couraud, MD, PhD, and colleagues wrote in the journal. France is no exception—but the locals have historically low turnout rates for cancer screenings of any kind.

“The success and effectiveness of cancer screening programs is closely linked to participation rates within the eligible population,” Couraud, of Lyon Sud Hospital and Lyon University Cancer Institute, and co-authors said. “Participation in cancer screening programs is a major concern in France, where rates remain relatively low.”

Just over than half of eligible women participated in breast cancer screenings in the country in 2015, according to the researchers, and colorectal cancer screening participation between 2013 and 2014 was similarly low, bottoming out at 29.8 percent.

The EDIFICE, a nationwide database of observational surveys, seeks to assess behavior related to those low screening rates, the authors explained. The surveys—targeted toward participants who meet French national screening criteria—aim to offer insight into the phenomenon.

“To the best of our knowledge, little has been published about the factors that influence a person’s decision to take part in a lung cancer screening program in a country where participation is low,” Couraud et al. wrote. “In this study, we investigated the factors likely to influence an individual’s participation in a hypothetical lung cancer screening program among a population of French 40- to 75-year-old former and current smokers.”

Couraud and his team were able to collect 1,463 EDIFICE survey responses from both current and former smokers for their research, according to the paper. Of those respondents, none of whom had any personal history of cancer, 36.4 percent of current smokers and 26.3 percent of former smokers said they were willing to take part in a lung cancer screening program.

Those who’d previously undergone testing for lung cancer were nearly three times more likely to repeat the experience, the authors reported, while women and those who smoked less than 30 pack-years were less likely to agree to screening. An absence of social vulnerability and intention to quit smoking were also positive influencers for testing.

Couraud et al. said women’s aversion to screening might have something to do with excessive radiation exposure, since women would be undergoing both breast and lung cancer screenings each year. But conflicting data on the subject have been published, they wrote, and compliance to France’s organized breast cancer screening program remains low.

“Our findings highlight the discrepancy that exists between target populations and individuals who actually intend to participate in a screening program for lung cancer, with the subsequent potential impact on participation rates and thus on the efficacy of screening,” the authors said. “However, the public health context of each country very likely has a considerable impact on the intention to participate in screening programs.”

There’s likely a poor understanding of cancer as a disease in France, Couraud and colleagues said, and the country’s people lack confidence in its prevention programs. Surveys like these should prompt more effective, streamlined services.

“The discrepancies between the characteristics of high-risk target populations and factors related to individual willingness to participate in cancer screening are a crucial consideration,” the authors wrote. “Factors associated with refusal to participate should be carefully considered in marketing strategies, information policies and education sessions in order to optimize selection of the population to be screened and thus optimize screening efficiency.”